Surgical instrument system

ABSTRACT

A surgical instrument system, in particular, for use in non-endoscopic surgery having a surgical instrument provided with a shaft in which a supply channel having a distally disposed liquid emergence opening and an evacuation channel having a distally disposed liquid draw-off opening, and a pump device which pumps a liquid into the supply channel with such a pressure that the tissue in front of the distal end of the surgical instrument is separated along natural separation planes by the liquid emerging from the emergence opening, and the liquid out of the liquid bubble surrounding the distal end of the surgical instrument is pumped through the evacuation channel to the proximal end of the surgical instrument.

DESCRIPTION

1. Technical Field

The present invention relates to a surgical instrument system, inparticular, for use in non-endoscopic surgery.

2. State of the Art

In endoscopic surgery, the instruments are inserted into naturalcorporal cavities through existing or artificially created entrances.Thus, the corporal cavity can be “inflated” by means of a gas, forinstance CO₂, during the surgical measure and in this manner create ormaintain the “operation area” for the surgical procedure.

Conventional non-endoscopic surgery, i.e. surgery in which the humanbody is opened and the operation measures are not carried out in anatural corporal cavity, often anatomically given points of cutting areused to gain “access” into the body. Preferably, work is conducted alongso-called planes of separation or cutting planes. Contrary to corporalcavities, the different possible planes of separation are interconnectedso that it is, in particular, impossible to use a gas that is underpressure for expanding and for scavenging the area immediatelysurrounding the instrument. One problem in surgery is, i.a., to move the(surgical) instrument gently forward along such types of natural cuttingplanes respectively planes of separation in the body.

In the present description, cutting planes or planes of separation referto, for example, areas where different corporal layers or tissue layers,such as for instance different muscle tissue (layers) or muscle tissueand fat tissue or fat tissue and veins are adjacent to each other. Inplain words, these types of planes are the interfaces between differentregions, of which each can, in particular, be homogeneous.

SUMMARY OF THE INVENTION

The object of the present invention is to create a surgical instrumentsystem that can be used in the human body or in animal bodies, inparticular, in conventional, non-endoscopic surgery and that can bemoved forward in a simple manner along natural cutting planes or planesof separation.

An invented solution to this object is based on the knowledge thatwater, in circumstances containing dissolved substances, such as salts,etc., is an ideal distention element for widening or separating corporaltissue along interfaces respectively planes of separation.

An element of the present invention is therefore that after opening thebody, i.e. after creating an entrance, a surgical instrument is insertedfrom whose distal end a liquid jet emerges which “widens” or “separates”the tissue so that a liquid bubble or a “water bubble” can move forwardin the center of natural cutting planes, which allow the surgicalinstrument to advance, in particular, without severing homogeneoustissue regions.

The added liquid is pumped off again using such evacuation power that(preferably) only one liquid bubble forms surrounding the distal end ofthe surgical instrument. In this way, the instrument can be movedforward along a natural cutting plane or a plane of separation, and theseparation plane is opened by the pressure of the emerging liquid to atleast such a degree that the surgical instrument can be inserted andmoved forward. On the other hand, the pumping off of the liquid throughthe liquid bubble prevents too much liquid from being introduced, whichwould “flood” the surgical field.

Therefore, the invented surgical instrument system, which is designed,in particular, for use in non-endoscopic surgery, is provided with

a surgical instrument having a shaft in which a supply channel with adistally disposed emergence opening for the liquid and a evacuationchannel with a distally disposed draw-off opening for the liquid areprovided, and

a pump device which pumps a liquid into the supply channel with such apressure that the tissue in front of the distal end of the surgicalinstrument is separated along the natural planes of separation by theliquid emerging from the emergence opening, and which pumps the liquidout of the liquid bubble surrounding the distal end of the surgicalinstrument through the evacuation channel to the proximal end of thesurgical instrument.

Preferably a surgical channel which permits the insertion of treatmentinstruments, such as instruments for cutting, expanding or coagulating,is provided in the shaft, in particular, in its center. In this way, theinstrument not only can move forward along the planes of separation butsurgery can also be performed without changing instruments.

In order to be able to observe the forward movement of the instrument aswell as the performance of the surgical procedure, it is moreoverpreferred if the shaft is provided at with an endoscope optic or if theshaft is provided with a channel into which an endoscope optic can beinserted. In order to be able to observe the instrument advancing, inparticular, if the endoscope optic is disposed off center, it isadvantageous if the lens of the endoscope optic has a viewing directionoptical axis respectively a lens-side optical axis which forms a smallangle, which can be e.g., approximately 12°, with the longitudinal axisof the shaft.

Fundamentally, a variety of instruments, such as are in particular knownfrom endoscopy, can be utilized as “surgical shaft instruments”.

However, it is preferred if the shaft has the basic construction of alaparoscope with a laterally offset observation means or eyepiece sothat there is one continuous channel in the laparoscope. According tothe present invention, a twin hollow needle, in which the supply channeland the evacuation channel are provided, is inserted into this channel.Moreover, the surgical channel can also be provided in the twin hollowneedle, preferably in the center. The central disposal of the surgicalchannel yields an advantageous rinsing of the instrument inserted intothe surgical channel.

If using a twin hollow needle in which the supply channel and theevacuation channel are provided, it is furthermore preferred if theseare provided with the two connections for the pump device. Theseconnections can be constructed in a variety of ways, for example asLuer-lock connections.

The pump device, for example, can be a (Sero) conditioning pump,regulated by an electronic control unit. The control unit regulates, orcontrols the pressure under which the liquid emerges in such a mannerthat it is adapted to the consistency or the density of the tissuelayers to be separated. In a number of applications, it is preferred ifthe pressure under which the liquid emerges is between approximately 0.1bar and approximately 1 bar.

BRIEF DESCRIPTION OF THE DRAWING

The present invention is described in the following, without theintention of limiting the scope or spirit of the overall inventive idea,using preferred embodiments with reference to the drawing by way ofexample, to which reference is explicitly made with regard to all theinvented details not disclosed herein. Depicted are in:

FIG. 1 a lateral view of an instrument employed according to the presentinvention, and

FIG. 2 a twin hollow needle constructed according to the presentinvention.

FIG. 3 is a cross sectional view of the twin hollow needle of FIG. 2.

DESCRIPTION OF A PREFERRED EMBODIMENT

FIG. 1 shows an instrument, which can be employed in accordance with thepresent invention as a “surgical shaft instrument”.

This instrument has the basic construction of a known laparoscope 1having a lateral viewing means or eyepiece 11 and a connection 12 for alight conductor cable by means of which the instrument is connected to anot depicted light source. The light from the light source illuminatesthe object field lying before the distal end 2 of the laparoscope 1,which can be viewed by means of lens, image conveyors, containing rodlens relay systems or image fiber bundles, none of which is shown forclarity and eyepiece 11. A video unit can be flanged, in a known manner,to an eyepiece 11.

Laparoscopes of this type are manufactured, for example, by Karl StorzGmbH & CO., Tuttlingen, Germany. For the explanation of all details notdescribed in more detail herein, reference is explicitly made to theconstruction of these instruments.

In the illustrated preferred embodiment, the instrument is provided withan endoscope lens having an oblique lens-side optical axis. The lensside forms preferably an angle of approximately 12° with the instrumentaxis A.

Moreover, laparoscope 1 is provided, in an as such known manner, with acentrally disposed channel 3 which connects the distal end 2 with theproximal end 4 of instrument 1 and into which other instruments can beinserted.

An element of the present invention is that a special hollow needle 31,which is depicted in more detail in FIG. 2 and is described in moredetail below, can be inserted into channel 3.

Hollow needle 31 depicted in more detail in FIG. 2 is inserted intolaparoscope 1 and preferably connected to it via an as such knownstandard coupling. Hollow needle 31 is provided with a channel 5 throughwhich the different instruments, such as dissecting instruments,scissors, HF instruments etc., required for performing a surgicalprocedure can be conveyed to distal end 2.

Furthermore, hollow needle 31 can be provided with two hollow channels,which are diagrammatically depicted in FIG. 3 and of which one is asupply channel 10 for a liquid with a distally disposed liquid emergenceopening and the other 12 is a evacuation channel with a distallydisposed liquid draw-off opening. Further, the needle 31 can have acentral channel 14 provided for receiving an surgical instrument.

These two channels can, in particular, be disposed on opposite sides ofchannel 5.

The supply channel 10 and the evacuation channel 12 are connected viatwo Luer connections 61 and 62 with a pump device 63, which canpreferably be a pump of the type Sero conditioning pump.

Furthermore, an electronic control unit 64 is provided which regulatesthe pump device. The control unit, in particular, regulates the pressurewith which the fluid, which, in particular, can be water incircumstances containing additives, emerges from the distally disposedemergence opening 65, and with which the liquid from the liquid bubblesurrounding the distal end 2 of the instrument is drawn off. Independence on the density and the consistency of the to-be-separatedtissue, the pressure with which the liquid emerges can typically rangebetween 0.1 bar and 1 bar. These pressures are distinctly higher thanthe pressures employed in the fields of endoscopy and, in particular,laparoscopy for continuous rinsing, as are for example described in U.S.Pat. No. 5,392,765.

An element of the present invention is that the pump unit 63, used torinse and evacuate, creates a water bubble which expands the tissuealong natural separation planes. This “water bubble” permits moving theinstrument combination (laparoscope, hollow needle andinstrument)forward into the tissue.

Thanks to the 12° oblique optic, the surgeon continuously sees theemployed instrument, which in particular can be somewhat longer than thechannel into which the instrument is inserted.

In the preceding, the present invention is described using a preferredembodiment. Of course, a variety of different modifications are possiblewithin the scope of general inventive idea:

Thus, the distal emergence opening of the supply channel can beconstructed as a nozzle in order to increase the efficiency of the“water-jet cutting” respectively “water-jet separation” performedaccording to the present invention.

Furthermore, the given pressure values are not restricting; inindividual cases exceeding them or falling short is possible.

What is claimed is:
 1. A surgical instrument system comprising: anelongate shaft with a proximal end and a distal end for insertion into ahuman or animal body to be treated, the shaft being provided thereinwith a supply channel for a liquid, the supply channel having a distallydisposed liquid emergence opening, and an evacuation channel having adistally disposed liquid draw-off opening; a pump device connected to aproximal end of the supply channel for pumping a liquid into the supplychannel so that the liquid emerges from the emergence opening at thedistal end, and also connected to the proximal end of the evacuationchannel for drawing-off liquid surrounding the distal end of theevacuation channel through the evacuation channel; and an electroniccontrol unit which controls the pump device so that the pressure withwhich the liquid emerges from the emergence opening and the pressurewith which the liquid is drawn into the evacuation channel are such asto maintain a bubble of liquid at the end of the instrument.
 2. Asurgical instrument system according to claim 1 characterized by thefact that said shaft further includes a viewing channel, said viewingchannel receiving an endoscope optic.
 3. A surgical instrument systemaccording to claim 2, characterized by the fact that the lens of saidendoscope optic has one viewing direction which forms a small angle withthe longitudinal axis of said shaft.
 4. A surgical instrument systemaccording to claim 4, characterized by the fact that said small angle isapproximately 12°.
 5. A surgical instrument system according to claim 1,characterized by the fact that said shaft further includes a surgicalchannel passing therethrough which is adapted to receive a treatmentinstrument.
 6. A surgical instrument system according to claim 5,characterized by the fact that said surgical channel is provided in thecenter of said shaft.
 7. A surgical instrument system according to claim1 characterized by the fact that said shaft has the basic constructionof a laparoscope having a laterally offset viewing.
 8. A surgicalinstrument system according to claim 1, characterized by the fact thatsaid liquid is water.
 9. A surgical instrument system according to claim1, characterized by the fact that said pressure under which said liquidemerges ranges between approximately 0.1 and approximately 1 bar.
 10. Asurgical instrument system according to claim 1, characterized by thefact that the pressure with which said liquid emerges from the emergenceopening is adapted to the consistency or density of the to-be-separatedtissue layers.
 11. A surgical process for separating tissue comprisingthe steps of: opening a body to expose the tissue; inserting aninstrument provided with supply and evacuation channels, said channelshaving a liquid emergence opening and a draw-off opening, respectively,which are distally disposed; forming a bubble of the liquid bycontrollably pumping liquid through the supply channel and out theemergence opening through the evacuation channel simultaneously; andmoving the instrument to separate the tissue along the naturalseparation planes.
 12. The surgical process of claim 11 including thestep of pumping liquid out of the body through the draw-off opening.